Provider & Payor Credentialing Specialist 24-00898

$62,400 - $74,880/Yr

Alura Workforce Solutions - Long Beach, CA

Full-time - Mid Level

Remote - Long Beach, CA

1-10 employees

About the position

The Credentialing & Payor Enrollment Representative plays a crucial role in ensuring that healthcare providers, including MDs, DOs, and PAs, meet all necessary standards and qualifications. This position involves managing the entire credentialing process, from collecting and verifying provider credentials to coordinating payor enrollment, thereby directly impacting the quality of care provided by the organization.

Responsibilities

• Process and manage all aspects of credentialing for healthcare providers within a managed care organization.
• Collect, review, and verify provider credentials, including licenses, certifications, education, and work history.
• Conduct primary source verification of credentials through various databases and organizations.
• Maintain accurate and up-to-date provider files and credentials with insurance payors including HMO, MSO, IPA's, Medical Groups, Medicare, and Medi-Cal, using CAQH, PECOS, and PAVE.
• Coordinate with internal departments and external entities to obtain necessary documentation and information.
• Assist in the development and implementation of credentialing policies and procedures.
• Respond to inquiries from providers regarding their credentialing status.

Requirements

• 2 years of full-cycle credentialing experience in credentialing standards, regulations, and best practices required.
• Experience credentialing providers with insurance payors such as HMO, MSO, IPA's, Medical Groups, Medicare, and Medi-Cal, using CAQH, PECOS, and PAVE required.
• Strong attention to detail and excellent organizational skills.
• Experience in provider enrollment follow-ups.
• Excellent written and verbal communication skills.
• Proficient in Microsoft Office Suite.

Benefits

• Two remote workdays each month
• Employee incentives
• Awards and outings
• Recognition for special achievements